European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 12, pp 3373–3381 | Cite as

The efficacy of diluted topical povidone-iodine rinses in the management of recalcitrant chronic rhinosinusitis: a prospective cohort study

  • Rikesh Panchmatia
  • Jennifer Payandeh
  • Rami Al-Salman
  • Emily Kakande
  • Al-Rahim Habib
  • Warren Mullings
  • Amin R. JaverEmail author



Recalcitrant chronic rhinosinusitis is a persistent inflammatory condition of the sinonasal mucosa despite adequate medical therapy and sinus surgery. This study aimed to demonstrate the effectiveness and safety of dilute povidone-iodine (PVP-I) sinonasal rinses as an adjunctive therapy.


Prospective cohort study. Twenty-nine recalcitrant CRS patients with endoscopic evidence of ongoing inflammation and purulent discharge were prescribed 0.08% diluted PVP-I rinses. Changes to endoscopic modified Lund–Kennedy (MLK) scores at 7 weeks post-PVP-I rinsing served as the primary outcome measure.


The median MLK-discharge score significantly decreased in all patients by 1.50 points post-PVP-I rinsing (p value < 0.01). The total MLK score significantly decreased in all patients by 1.50 points (p value = 0.01). Up to a 17% reduction in serum inflammatory markers was measured post-PVP-I rinsing. Sinonasal culture revealed a shift from moderate–heavy growth to lighter bacterial growth overall. Subjective SNOT-22 scores significantly improved overall by ≥ 1 minimal clinically important difference (MCID > 12; baseline median = 33; follow-up median = 20; p value < 0.01; n = 22). TSH levels increased non-significantly within normal ranges (baseline median = 1.59 mU/L; follow-up median = 1.92 mU/L; p = 0.10; n = 15). Mucociliary clearance time increased non-significantly within normal ranges (baseline median = 9 min; follow-up median = 10 min; p value = 0.53; n = 17). Olfactory Sniffin’16 scores non-significantly decreased within age-related normal ranges (baseline median = 14; follow-up median = 13; p value = 0.72; n = 18).


A dilute 0.08% PVP-I sinonasal rinse as an ancillary therapy in recalcitrant CRS significantly reduces signs of infection alongside notable symptom improvement, without affecting thyroid function, mucociliary clearance or olfaction.


Povidone-iodine Betadine Chronic rhinosinusitis Recalcitrant Endoscopy Treatment 



The authors acknowledge Sara Derikvand and India Dhillon for assistance with ethics application as well as the conduct of the study.

Author contributions

RP: study design, data collection, data analysis and manuscript preparation. JP: study design, data collection, data analysis and manuscript preparation. RA: data collection and manuscript review. EK: data collection and manuscript review. AH: sample size calculation and manuscript review. WM: study design, data collection and manuscript review. ARJ (primary investigator): study design, manuscript review.


No sources of funding were received for the study.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Rikesh Panchmatia
    • 1
  • Jennifer Payandeh
    • 1
  • Rami Al-Salman
    • 1
  • Emily Kakande
    • 1
  • Al-Rahim Habib
    • 1
  • Warren Mullings
    • 1
  • Amin R. Javer
    • 1
    Email author
  1. 1.Division of OtolaryngologySt. Paul’s Sinus Centre, University of British ColumbiaVancouverCanada

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